Hello all,

I am requesting some assistance for a fellow IBCLC who is not on-line.
She is having some difficulty coming up with solutions with a mom/baby
pair having difficulty with latch.

The mom has been working with the lactation consultant beginning in the
antenatal period and both mom and dad are very motivated to breastfeed.
She has continued to work with them since the infant's birth 3 weeks
ago.

The problem with the latch seems to be infant related in that the tongue
appears to be short, the chin recedes and the infant does not fully
extend the tongue for proper positioning.  When the LC works with the
mom, they are able to latch appropriately, but have great difficulty
without assistance, despite the variety of positions attempted.  Initially,
there were problems with tongue thrusting and sucking on lower lip,
which have been resolved at this point. The LC has tried a variety of
methods to relax the infant and assist in tongue extension, including
facial massage.  The mom has been pumping and feeding EBM with a
bottle, so the infant has appropriate weight gain and is thriving.  The
mother has very large breasts and ample milk supply.  The mom very
much wants to lose the pump and feed the baby at breast.

The mother's history revealed a strong family tendency for feeding
difficulties with a bottle/nipple (herself, siblings) and subsequent speech
problems in these same individuals.  Because of the infant oral anatomy
observations made by the LC and maternal history, the infant was
referred to a local pediatrician for examination.  The ped did not find
anything unusual in her exam.  This was disheartening for all and they
are questioning whether they should get a second opinion.

This LC would like to take advantage of your expertise in considering
some options which would increase their success with the latch. My
suggestion at the present time (she meets with this client today) is to
lose the bottle/nipple altogether.  I suggested she attempt cupfeeding in
conjunction with breast-feeding to provide the baby with nutrition, to
correct any problems caused by nipple confusion and to train the tongue
for proper extension (to the best of this infant's ability).  I just read an
article from a recent JHL yesterday which discussed improper cup
feeding technique.  In this article (of course I don't have the reference
handy), the author emphasized the importance of proper technique to
assist the infant in learning to control the feedings with the tongue,
which I see as having a beneficial potential in this infant.  Hopefully, this
will lead to fully feeding at the breast if the tongue responds to this
training.  It may also buy a little time for the baby to become more
effective as a result of growth and development.  I also suggested she
use a towel to support mothers large breasts and assist in positioning for
proper latch.

This LC was wondering if you were aware of any resources which
picture variations in infant oral anatomy to use in an attempt to identify or
name a particular problem or syndrome.  Also, any helpful techniques
would be appreciated if you have worked with a similar situation.

Thanks so much,
Cindy Anderson, MS, CNS, IBCLC
College of Nursing, UND